What is the diagnosis and treatment for Urosepsis (Urinary Tract Infection-related Sepsis)?

From the Guidelines

Urosepsis should be promptly diagnosed and treated with intravenous antimicrobial regimens, such as fluoroquinolones, aminoglycosides, or extended-spectrum cephalosporins, and supportive care to reduce morbidity, mortality, and improve quality of life. The diagnosis of urosepsis typically involves urinalysis, urine culture, and antimicrobial susceptibility testing, as well as evaluation of the upper urinary tract via ultrasound to rule out urinary tract obstruction or renal stone disease 1.

Initial Management

Initial management of urosepsis includes:

• Starting intravenous antibiotics immediately, such as a fluoroquinolone, an aminoglycoside (with or without ampicillin), or an extended-spectrum cephalosporin or penicillin 1
• Fluid resuscitation with crystalloids (e.g., normal saline) to maintain organ perfusion and oxygenation
• Obtaining blood and urine cultures before starting antibiotics, if possible without delaying treatment
• Monitoring vital signs closely, including blood pressure, heart rate, respiratory rate, and urine output

Antibiotic Selection

The choice of antibiotics should be based on local resistance patterns and optimized, with carbapenems and novel broad-spectrum antimicrobial agents reserved for patients with early culture results indicating the presence of multidrug-resistant organisms 1.

Supportive Care

Supportive measures aim to maintain organ perfusion and oxygenation, and may include vasopressors (e.g., norepinephrine) if hypotension persists despite fluid resuscitation, and relieving urinary obstruction if present (e.g., removing an obstructed catheter, placing a nephrostomy tube) 1.

Key Considerations

Key considerations in the management of urosepsis include prompt differentiation between uncomplicated and potentially obstructive pyelonephritis, as the latter can swiftly progress to urosepsis, and the use of appropriate imaging techniques to establish this delineation 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ceftriaxone for Injection and other antibacterial drugs, Ceftriaxone for Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae BACTERIAL SEPTICEMIA Caused by Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae or Klebsiella pneumoniae

The diagnosis of Urosepsis (Urinary Tract Infection-related Sepsis) is typically made based on the presence of a urinary tract infection and signs of sepsis. The treatment for Urosepsis typically involves the use of antibiotics such as Ceftriaxone 2 that are effective against the causative organisms. Cefepime 3 and Gentamicin 4 may also be used to treat Urosepsis, depending on the severity of the infection and the susceptibility of the causative organisms. Key considerations in the treatment of Urosepsis include:

• Identifying the causative organism and its susceptibility to antibiotics
• Selecting an antibiotic that is effective against the causative organism
• Administering the antibiotic promptly and in an appropriate dose
• Monitoring the patient's response to treatment and adjusting the antibiotic regimen as needed.

From the Research

Diagnosis of Urosepsis

• Urosepsis is defined as sepsis caused by an infection in the urogenital tract 5, 6, 7, 8, 9
• The quick sequential organ failure assessment is replacing the systemic inflammatory response syndrome scoring for rapid identification of patients with urosepsis 5
• Urine cultures and blood cultures should be performed before antibiotic treatment 6
• Imaging of urinary tract disorders has been shown to be useful in decreasing mortality from urosepsis 5

Treatment of Urosepsis

• Management of urosepsis comprises four major aspects: (1) early diagnosis, (2) early empiric intravenous antimicrobial treatment, (3) identification and control of complicating factors, and (4) specific sepsis therapy 5, 7, 9
• Empirical antibiotic therapy should be instigated within the first hour after diagnosis 6
• The empirical treatment consists of a broad spectrum beta-lactam antibiotic, such as piperacillin/tazobactam, carbapenems, or the new cephalosporin/beta-lactamase inhibitor (BLI) combinations 6
• Combination therapy with cephalosporins and aminoglycosides or fluoroquinolones may be used, but should be de-escalated to monotherapy after 48-72 hours 6
• Early fluid resuscitation, early antibiotic use, and control and elimination of susceptibility factors are key to treating urosepsis 8
• Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria 7